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Aboriginal experiences of aging and dementia in a context of sociocultural change: qualitative analysis of key informant group interviews with Aboriginal seniors.

https://arctichealth.org/en/permalink/ahliterature137393
Source
J Cross Cult Gerontol. 2011 Mar;26(1):103-17
Publication Type
Article
Date
Mar-2011
Author
Shawnda Lanting
Margaret Crossley
Debra Morgan
Allison Cammer
Author Affiliation
Department of Psychology, University of Saskatchewan, Arts Building, 9 Campus Drive, S7N 5A5 Saskatoon, SK, Canada. shawnda.lanting@usask.ca
Source
J Cross Cult Gerontol. 2011 Mar;26(1):103-17
Date
Mar-2011
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Aging - ethnology - psychology
Cultural Evolution
Dementia - ethnology - psychology
Family
Female
Health Knowledge, Attitudes, Practice
Humans
Indians, North American - psychology
Interviews as Topic
Neuropsychological Tests
Qualitative Research
Saskatchewan
Abstract
Examining the role of culture and cultural perceptions of aging and dementia in the recognition, diagnosis, and treatment of age-related cognitive impairment remains an understudied area of clinical neuropsychology. This paper describes a qualitative study based on a series of key informant group interviews with an Aboriginal Grandmothers Group in the province of Saskatchewan. Thematic analysis was employed in an exploration of Aboriginal perceptions of normal aging and dementia and an investigation of issues related to the development of culturally appropriate assessment techniques. Three related themes were identified that highlighted Aboriginal experiences of aging, caregiving, and dementia within the healthcare system: (1) cognitive and behavioural changes were perceived as a normal expectation of the aging process and a circular conception of the lifespan was identified, with aging seen as going back "back to the baby stage", (2) a "big change in culture" was linked by Grandmothers to Aboriginal health, illness (including dementia), and changes in the normal aging process, and (3) the importance of culturally grounded healthcare both related to review of assessment tools, but also within the context of a more general discussion of experiences with the healthcare system. Themes of sociocultural changes leading to lifestyle changes and disruption of the family unit and community caregiving practices, and viewing memory loss and behavioural changes as a normal part of the aging process were consistent with previous work with ethnic minorities. This research points to the need to understand Aboriginal perceptions of aging and dementia in informing appropriate assessment and treatment of age-related cognitive impairment and dementia in Aboriginal seniors.
PubMed ID
21287400 View in PubMed
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Availability and acceptability of Canadian home and community-based services: perspectives of family caregivers of persons with dementia.

https://arctichealth.org/en/permalink/ahliterature154656
Source
Home Health Care Serv Q. 2008;27(2):75-99
Publication Type
Article
Date
2008
Author
Dorothy A Forbes
Maureen Markle-Reid
Pamela Hawranik
Shelley Peacock
Dawn Kingston
Debra Morgan
Sandra Henderson
Beverley Leipert
S Lynn Jansen
Author Affiliation
School of Nursing, The University of Western Ontario, London, Ontario, CA. dforbes6@uwo.ca
Source
Home Health Care Serv Q. 2008;27(2):75-99
Date
2008
Language
English
Publication Type
Article
Keywords
Aged, 80 and over
Canada
Caregivers - psychology
Consumer Satisfaction
Dementia
Family
Female
Focus Groups
Health Services Accessibility
Home Care Services - economics - statistics & numerical data
Humans
Male
Rural Population
Urban Population
Abstract
Thirty-five percent of Canadians over the age of 85 have dementia, and up to 90% of their home care is provided by family and friends. The purpose of this study was to explore the use and satisfaction with home and community-based services for persons with dementia from the perspectives of family caregivers. The study was conducted using an interpretive, descriptive, qualitative approach. Six focus groups (N = 36) and three personal interviews were conducted with rural and urban caregivers in Ontario, Manitoba, and Saskatchewan, Canada. Using Lubrosky's (1994) thematic analysis, the overarching themes identified were availability and acceptability of services. The findings suggest a need for an integrated continuing care model that includes the person living with dementia and their family caregivers as partners in care, addresses all of the determinants of health, and embraces sensitivity, diversity, flexibility, and supportive services to enhance the availability and acceptability of Canadian home and community-based services.
PubMed ID
18928206 View in PubMed
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Barriers to participation in continuing education activities among rural and remote nurses.

https://arctichealth.org/en/permalink/ahliterature164328
Source
J Contin Educ Nurs. 2007 Mar-Apr;38(2):58-66; quiz 67-8, 93
Publication Type
Article
Author
Kelly Penz
Carl D'Arcy
Norma Stewart
Julie Kosteniuk
Debra Morgan
Barbara Smith
Author Affiliation
College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
Source
J Contin Educ Nurs. 2007 Mar-Apr;38(2):58-66; quiz 67-8, 93
Language
English
Publication Type
Article
Keywords
Adult
Attitude of Health Personnel
Canada
Clinical Competence
Cross-Sectional Studies
Education, Distance - organization & administration
Education, Nursing, Continuing - organization & administration
Employment - organization & administration
Female
Humans
Job Satisfaction
Male
Medically underserved area
Middle Aged
Needs Assessment - organization & administration
Nursing Education Research
Nursing Methodology Research
Nursing Staff - education - organization & administration - psychology
Qualitative Research
Questionnaires
Rural Population - statistics & numerical data
Socioeconomic Factors
Time Factors
Training Support - organization & administration
Travel
Abstract
This article examines the barriers to participation in continuing education activities that are perceived by rural and remote registered nurses in Canada.
The data are drawn from a national survey that was part of a larger national project, "The Nature of Nursing Practice in Rural and Remote Canada."
Perceived barriers to participation in continuing education activities include the isolation of rural nurses and time and financial constraints. Nurses who perceived barriers to participation were more likely to be middle-aged, unmarried, and working full-time than nurses who did not perceive barriers. They were also more likely to possess higher levels of nursing education and have children or dependents. The perception of barriers to participation was also associated with lower job and scheduling satisfaction.
Rural and remote registered nurses have moderately high levels of participation in continuing education; however, participation and job satisfaction can be improved if some of the barriers identified are addressed.
PubMed ID
17402377 View in PubMed
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Diagnoses of anxiety and depression in clinical-scenario patients: survey of Saskatchewan family physicians.

https://arctichealth.org/en/permalink/ahliterature126108
Source
Can Fam Physician. 2012 Mar;58(3):e144-51
Publication Type
Article
Date
Mar-2012
Author
Julie Kosteniuk
Debra Morgan
Carl D'Arcy
Author Affiliation
Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, 103 Wiggins Rd, Saskatoon, SK S7N 0W8. julie.kosteniuk@usask.ca
Source
Can Fam Physician. 2012 Mar;58(3):e144-51
Date
Mar-2012
Language
English
Publication Type
Article
Keywords
Adult
Analysis of Variance
Anxiety - diagnosis
Chi-Square Distribution
Cross-Sectional Studies
Depressive Disorder, Major - diagnosis
Diagnosis, Differential
Family Practice
Female
Group Practice
Humans
Male
Middle Aged
Questionnaires
Saskatchewan
Time Factors
Abstract
To investigate family physicians' differential diagnoses of clinical-scenario patients presenting with symptoms of either generalized anxiety disorder (GAD) or a major depressive episode (MDE).
Cross-sectional survey.
Saskatchewan.
A total of 331 family physicians practising in Saskatchewan as of December 2007.
Type and number of physicians' differential diagnoses for a GAD-scenario patient and an MDE-scenario patient.
The survey response rate was 49.7% (331 of 666 surveys returned). Most physicians suggested a diagnosis of anxiety (82.5%) for the GAD-scenario patient and a diagnosis of depression (84.2%) for the MDE-scenario patient. In descending order, the 5 most frequent differential diagnoses for the GAD-scenario patient were anxiety, hyperthyroidism, depression, panic disorder or attack, and bipolar disorder. The 5 most frequent differential diagnoses for the MDE-scenario patient were depression, anxiety, hypothyroidism, irritable bowel syndrome, and anemia. Neither a diagnosis of anxiety nor a diagnosis of depression was associated with physicians' personal attributes (sex, age, and years in practice) or organizational setting (number of total patient visits per week, private office or clinic, solo practice, Internet access, and rural practice setting). However, physicians in solo practice suggested fewer differential diagnoses for the GAD-scenario patient than those in group practice; physicians in practice 30 years or longer suggested fewer differential diagnoses for the MDE-scenario patient than those in practice fewer than 10 years. On average, physicians suggested 3 differential diagnoses for each of the scenarios.
Most family physicians recognize depression and anxiety in patients presenting with symptoms of these disorders and consider an average of 3 differential diagnoses in each of these cases.
Notes
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PubMed ID
22423028 View in PubMed
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Diagnosis and treatment of dementia: 4. Approach to management of mild to moderate dementia.

https://arctichealth.org/en/permalink/ahliterature154868
Source
CMAJ. 2008 Oct 7;179(8):787-93
Publication Type
Conference/Meeting Material
Article
Date
Oct-7-2008
Author
David B Hogan
Peter Bailey
Sandra Black
Anne Carswell
Howard Chertkow
Barry Clarke
Carole Cohen
John D Fisk
Dorothy Forbes
Malcolm Man-Son-Hing
Krista Lanctôt
Debra Morgan
Lilian Thorpe
Author Affiliation
Departments of Medicine and Clinical Neurosciences, University of Calgary, Calgary, Alta. dhogan@ucalgary.ca
Source
CMAJ. 2008 Oct 7;179(8):787-93
Date
Oct-7-2008
Language
English
Publication Type
Conference/Meeting Material
Article
Keywords
Age Factors
Aged
Aged, 80 and over
Alzheimer Disease - diagnosis - therapy
Caregivers - psychology - statistics & numerical data
Combined Modality Therapy
Dementia - diagnosis - therapy
Evidence-Based Medicine
Female
Geriatric Assessment
Humans
Male
Neuropsychological Tests
Ontario
Physician-Patient Relations
Practice Guidelines as Topic
Prognosis
Risk assessment
Severity of Illness Index
Treatment Outcome
Abstract
The management of mild to moderate dementia presents complex and evolving challenges. Practising physicians are often uncertain about the appropriate approaches to issues such as the disclosure of the diagnosis, driving and caregiver support. In this article, we provide practical guidance on management based on recommendations from the Third Canadian Consensus Conference on the Diagnosis and Treatment of Dementia.
We developed evidence-based guidelines using systematic literature searches, with specific criteria for the selection and quality assessment of articles, and a clear and transparent decision-making process. We selected articles published from January 1996 to December 2005 that dealt with the management of mild to moderate stages of Alzheimer disease and other forms of dementia. Recommendations based on the literature review were drafted and voted on. Consensus required 80% or more agreement by participants. Subsequent to the conference, we searched for additional articles published from January 2006 to April 2008 using the same major keywords and secondary search terms. We graded the strength of evidence using the criteria of the Canadian Task Force on Preventive Health Care.
We identified 1615 articles, of which 954 were selected for further study. From a synthesis of the evidence in these studies, we made 48 recommendations for the management of mild to moderate dementia (28) and dementia with a cerebrovascular component (8) as well as recommendations for addressing ethical issues (e.g., disclosure of the diagnosis) (12). The updated literature review did not change these recommendations. In brief, patients and their families should be informed of the diagnosis. Although the specifics of managing comorbid conditions might require modification, standards of care and treatment targets would not change because of a mild dementia. The use of medications with anticholinergic effects should be minimized. There should be proactive planning for driving cessation, since this will be required at some point in the course of progressive dementia. The patient's ability to drive should be determined primarily on the basis of his or her functional abilities. An important aspect of care is supporting the patient's primary caregiver.
Much has been learned about the care of patients with mild to moderate dementia and the support of their primary caregivers. There is a pressing need for the development, and dissemination, of collaborative systems of care.
Notes
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Erratum In: CMAJ. 2008 Oct 21;179(9):932
PubMed ID
18838454 View in PubMed
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Gender differences in use and availability of home and community-based services for people with dementia.

https://arctichealth.org/en/permalink/ahliterature157345
Source
Can J Nurs Res. 2008 Mar;40(1):39-59
Publication Type
Article
Date
Mar-2008
Author
Dorothy A Forbes
S Lynn Jansen
Maureen Markle-Reid
Pamela Hawranik
Debra Morgan
Sandra Henderson
Beverly Leipert
Shelley Peacock
Dawn Kingston
Author Affiliation
School of Nursing, University of Western Ontario, London, Canada. dforbes6@uwo.ca
Source
Can J Nurs Res. 2008 Mar;40(1):39-59
Date
Mar-2008
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Canada - epidemiology
Community Health Services - utilization
Cross-Sectional Studies
Dementia - epidemiology - psychology
Female
Health Care Surveys
Health Services Accessibility - organization & administration
Health Services for the Aged - utilization
Home Care Services - utilization
Humans
Male
Men - psychology
Needs Assessment
Nursing Methodology Research
Outcome Assessment (Health Care)
Patient Acceptance of Health Care - psychology - statistics & numerical data
Questionnaires
Sex Factors
Women - psychology
Abstract
The purpose was to examine the use and availability of home and community-based services by men and women with dementia using data from the 2003 Canadian Community Health Survey. Variables of interest were based on the Andersen and Newman model and included predisposing, enabling, need, and use of health service variables, perceived unmet health and home care needs, and availability of home and community-based health services. Women reported better health and received more supportive care yet had more unmet home care needs than men.Thus, the caregivers of men with dementia (often their wives) were particularly vulnerable to negative outcomes, as their care recipients had poorer health yet received fewer services. These gender differences should be considered when policies and programs are developed, the needs of care recipients and caregivers are assessed, and services are provided.
PubMed ID
18459271 View in PubMed
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How do registered nurses define rurality?

https://arctichealth.org/en/permalink/ahliterature159399
Source
Aust J Rural Health. 2008 Feb;16(1):28-32
Publication Type
Article
Date
Feb-2008
Author
Judith C Kulig
Mary Ellen Andrews
Norma J Stewart
Norma L Stewart
Roger Pitblado
Martha L P MacLeod
Donna Bentham
Carl D'Arcy
Debra Morgan
Dorothy Forbes
Gail Remus
Barbara Smith
Author Affiliation
School of Health Sciences, University of Lethbridge, Lethbridge, Alberta, Canada. kulig@uleth.ca
Source
Aust J Rural Health. 2008 Feb;16(1):28-32
Date
Feb-2008
Language
English
Publication Type
Article
Keywords
Attitude of Health Personnel
Canada
Career Choice
Humans
Licensure, Nursing
Life Style
Medically underserved area
Nurse's Role - psychology
Nursing Methodology Research
Nursing Staff - education - organization & administration - psychology
Professional Practice Location
Qualitative Research
Questionnaires
Residence Characteristics
Rural health services - organization & administration
Rural Population - statistics & numerical data
Abstract
The objective of this analysis was to identify the meaning of rurality for registered nurses (RNs) practising in rural and remote Canada.
An existing Statistics Canada definition was used to stratify Canada's 10 provinces into urban and rural areas. As part of a national multi-method study, a random sample of RNs in these rural strata, plus all RNs working in outpost settings and northern territories, were surveyed concerning the nature of nursing practice. Content analysis was used to identify themes from an open-ended question: 'How do you define rural/remote?' Refinement of the themes was conducted by the survey team and credibility was supported through investigator triangulation.
Of the 3933 RNs who responded to the survey (68% response rate), 3412 provided a definition of rural/remote. A subsample of 1285 RNs was used for detailed thematic analysis because these respondents provided definitions with a clear referent to rural and/or to remote; the remaining sample was used for verification of themes.
Four defining themes were identified by RNs for both rural and remote: community characteristics, geographical location, health human and technical resources, and nursing practice characteristics.
The themes can be used as content domains or dimensions of rurality to improve our understanding of how to describe rural communities, including geographical location and nursing practice, from the perspective of RNs.
Notes
Erratum In: Aust J Rural Health. 2009 Dec;17(6):350Stewart, Norma L [corrected to Stewart, Norma J]
PubMed ID
18186719 View in PubMed
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Incidence and predictors of excess disability in walking among nursing home residents with middle-stage dementia: a prospective cohort study.

https://arctichealth.org/en/permalink/ahliterature145097
Source
Int Psychogeriatr. 2011 Feb;23(1):54-64
Publication Type
Article
Date
Feb-2011
Author
Susan E Slaughter
Misha Eliasziw
Debra Morgan
Neil Drummond
Author Affiliation
Faculty of Nursing, University of Alberta, Edmonton, Canada. susan.slaughter@ualberta.ca
Source
Int Psychogeriatr. 2011 Feb;23(1):54-64
Date
Feb-2011
Language
English
Publication Type
Article
Keywords
Age Factors
Aged
Aged, 80 and over
Antidepressive Agents - adverse effects
Canada - epidemiology
Cognition
Dementia - complications - nursing - physiopathology
Depression - drug therapy - prevention & control
Disability Evaluation
Female
Homes for the Aged
Humans
Incidence
Male
Mobility Limitation
Nursing Homes
Prospective Studies
Risk factors
Walking
Abstract
Inability to walk compromises the well-being of the growing number of nursing home residents with dementia. The purpose of this study was to estimate the incidence and identify predictors of walking disability that may be remediable.
A cohort was followed fortnightly for a year in 15 nursing homes in western Canada. The study participants comprised 120 ambulatory residents with middle-stage Alzheimer's, vascular or mixed dementia. Standardized measures of potential predictors of disability included the Charlson Comorbidity Index, Global Deterioration Scale, and Professional Environment Assessment Protocol. Walking disability was defined as using a wheelchair to go to meals in the dining room.
Incidence of walking disability was 40.8% (95% confidence interval (CI): 32.7-50.2). Approximately half of this (27.0%; 95% CI: 19.7-36.5) was excess disability. Residents with more advanced dementia and living in a less supportive nursing home environment experienced an increased hazard of walking disability (Hazard Ratio (HR): 2.1; 95% CI: 1.2-3.8 and HR: 2.4; 95% CI: 1.3-4.4 respectively). After adjusting for age, comorbidity and stage of dementia, predictors of excess disability in walking included using antidepressants (HR: 2.2; 95% CI: 1.02-4.6), and not using cognitive enhancers (HR: 2.6; 95% CI: 1.03-6.4).
Over half of walking disability in nursing home residents with middle-stage dementia may be modifiable. Creating supportive environments, ensuring access to cognitive enhancer drugs, and preventing and treating depression and the adverse effects of antidepressants, may help to reduce walking disability and excess disability.
PubMed ID
20199700 View in PubMed
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Individual determinants of home-care nursing and housework assistance.

https://arctichealth.org/en/permalink/ahliterature181815
Source
Can J Nurs Res. 2003 Dec;35(4):14-36
Publication Type
Article
Date
Dec-2003
Author
Dorothy A Forbes
Norma Stewart
Debra Morgan
Malcolm Anderson
Karen Parent
Bonnie L Janzen
Author Affiliation
College of Nursing, University of Saskatchewan, Saskatoon, Canada.
Source
Can J Nurs Res. 2003 Dec;35(4):14-36
Date
Dec-2003
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Age Factors
Aged
Analysis of Variance
Canada - epidemiology
Causality
Chronic Disease - epidemiology
Cross-Sectional Studies
Female
Geriatric Assessment
Health Care Surveys
Home Care Services - utilization
Homemaker Services - utilization
Housekeeping - utilization
Humans
Income - statistics & numerical data
Logistic Models
Male
Needs Assessment
Patient Acceptance of Health Care - psychology - statistics & numerical data
Sex Factors
Social Support
Abstract
The purpose of this study was to examine individual determinants of use of publicly funded home-care nursing and housework assistance by Canadians 18 years and older from 1994 to 1999. Andersen and Newman's Behavioural Model of Health Services Use guided the selection of variables, analyses, and interpretation of the findings. Descriptive, correlation, and multiple logistic regression analyses were completed in each of the first 3 cross-sectional cycles of Statistics Canada's National Population Health Surveys. The determinants of use of housework assistance were older age, female, living alone, lower income, activity restriction, needing help with housework, not hospitalized in the previous year, and having at least 1 chronic condition. The determinants for home nursing tended to be the opposite of those for housework assistance. Between 1994 and 1999, use of housework assistance appeared to decrease and use of nursing services appeared to remain relatively stable. The findings underscore the need to target these 2 discrete subgroups of home-care users and ensure that funding is directed at support services as well as nursing services.
PubMed ID
14746119 View in PubMed
Less detail
Source
Can Nurse. 2006 Apr;102(4):16-20
Publication Type
Article
Date
Apr-2006
Author
Judith C Kulig
Norma J Stewart
Debra Morgan
Mary Ellen Andrews
Martha L P MacLeod
J Roger Pitblado
Author Affiliation
School of Health Sciences, University of Lethbridge, Lethbridge, Alberta.
Source
Can Nurse. 2006 Apr;102(4):16-20
Date
Apr-2006
Language
English
Publication Type
Article
Keywords
Attitude of Health Personnel
Canada
Employment - organization & administration
Health status
Humans
Indians, North American - psychology
Job Satisfaction
Licensure, Nursing
Medically underserved area
Nurse's Role
Nursing Methodology Research
Nursing Staff - organization & administration - psychology
Professional Autonomy
Professional Practice Location
Questionnaires
Registries
Residence Characteristics
Rural health services - organization & administration
Workload
Abstract
Aboriginal registered nurses have been identified as an essential group in the delivery of health services in First Nations communities. Despite this, there is a lack of information about this group of nurses in Canada. This article presents information about this group taken from two components of a national study, The Nature of Nursing Practice in Rural and Remote Canada: documentary analysis and a national survey of nurses. The aboriginal nurse participants were predominantly female, between the ages of 40 and 49, diploma prepared and with licensure for less than 10 years. The survey data showed 41.4 per cent returned to their home communities to work. The participants noted how they enjoyed the challenges of rural and remote nursing and wanted to raise their families in these small communities. They have been able to create supportive work environments, particularly with their nursing colleagues. The nurses are committed to working in rural and remote communities.
PubMed ID
16734348 View in PubMed
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18 records – page 1 of 2.